Provider Demographics
NPI:1932956828
Name:CROTHERS, RUSTY A I
Entity type:Individual
Prefix:
First Name:RUSTY
Middle Name:A
Last Name:CROTHERS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HOOP RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9750
Mailing Address - Country:US
Mailing Address - Phone:937-779-2816
Mailing Address - Fax:
Practice Address - Street 1:740 HOOP RIDGE RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9750
Practice Address - Country:US
Practice Address - Phone:937-779-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK561815251E00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No251E00000XAgenciesHome Health